Design Justice

Teresa Chahine: Welcome to Impact & Innovation. I’m Teresa Chahine and I’m inviting you inside my classroom at Yale School of Management as we grapple with questions on social entrepreneurship and impact.

Welcome back, everyone. Thank you for joining us. I’m very excited to have with me here today a very special guest, Ashlee Wisdom, founder of Health in Her HUE, a tech startup focusing on health equity. Ashlee, you have a background in public health. You got your master’s in public health from New York University, and that’s one of the reasons I was so excited you agreed to come here today and speak to my students, because a lot of them are pursuing careers in public health, whether they’re MBA students or MPH students, and that usually to them doesn’t translate into a tech startup. So I’m really excited to dive into this conversation with you.

Ashlee Wisdom: I’m excited for the discussion as well.

Teresa Chahine: So let’s start by hearing a little bit about Health in Her HUE and what exactly it does.

Ashlee Wisdom: Health in Her HUE is a digital health platform focused on connecting Black women and women of color to culturally sensitive or culturally responsive healthcare providers, culturally tailored health content, and community support. So we have a provider directory where women can search for culturally responsive healthcare providers. They can search our content library for evidence-based health content that reflects doctors who look like them and highlights conditions and topics that disproportionately impact women of color. And then we have community support. So we have community forums where women can connect with other women of color who may have a similar diagnosis as them or may be going through a similar care journey.

Teresa Chahine: So that’s a lot. And usually that’s work that’s done by different players like hospitals, foundations, community health centers, nonprofits. It’s rare to hear health equity being talked about in this for-profit way. I know that right now you’re raising venture capital funding. Tell us, when you first started it, did you see this as a for-profit tech company? Did you know from the beginning that that was a business model you could pursue?

Ashlee Wisdom: Yes. I went into building Health in Her HUE for profit because I believed fundamentally that solving social problems, solving problems like the problem Health in Her HUE is addressing can be a viable business. That is the crux of a business, is finding a pain point for a customer and solving it for them. And I felt that a for-profit entity could make sense for what we were trying to address and solve.

Teresa Chahine: And also, probably if you were building this business for White women or even for White men, no one would be asking you that question.

Ashlee Wisdom: Right. And oftentimes people think when you’re building something for Black people or people of color, that it has to be some charitable right initiative. And it’s like, no, we are people too. We have pain points, and it’s a viable business, and our money is just as green as others’. And I leaned into that, and I also felt like I wanted to show with Health in Her HUE you can do well in society and drive impact and also have a viable, successful, and scalable business.

Teresa Chahine: And you were able to raise a lot of funding. So I learned a lot by hearing you speak to my students because in the past, I’ve heard entrepreneurs talk about, “Okay, at the beginning we bootstrap.” We just do what we can by the strings of our shoes, as they say. And then we have some kind of proof of concept or minimum viable product that we can test and share and potentially do some crowdfunding or raise money from angels or friends and family. And we call that pre-seed, to build something that will get us customers to go get seed funding from venture capitalists. And people talk about it as the friends and family or pre-seed or whatever is usually like a hundred thousand, two hundred thousand, and then you can go to venture capitalists and get a couple of million. But your pre-seed was $1.5 million. Right?

Ashlee Wisdom: Yeah.

Teresa Chahine: So you were thinking of that as the proof of concept stage.

Ashlee Wisdom: Yes.

Teresa Chahine: And now you’re doing, what’s it called that you’re doing now?

Ashlee Wisdom: The seed. Price seed round.

Teresa Chahine: Now you’re doing a price seed round, and then you’ll go for your Series A.

Ashlee Wisdom: Yes.

Teresa Chahine: Can you explain the distinction between all these three phases and is this something unique that you’re doing, going big from the beginning, or is this just what the field looks like now?

Ashlee Wisdom: The pre-seed is pretty standard across the board. What was unique for me is that I don’t come from or didn’t have a network naturally of super high-net-worth individuals or wealthy people that I could just raise a couple of thousands of dollars or fifty thousand dollars here and there to build a proof of concept. I had to bootstrap with my own income for a couple of years, and then I raised a pre-seed, and what was different from my pre-seed, and not quite unique for everyone, some people have institutional investors invest in their pre-seed or friends and family round. Our pre-seed was a lot of angel investors, but we also did have some institutional VCs. And those VCs were healthcare focus or women focus or BIPOC focus VC fund. So they made sense in terms of our mission alignment. Our seed round, seed is typically where you are pitching primarily to venture capitalists, and you may have some angel investors or what they call angel syndicates, which are groups of angel investors that invest their capital together into a company. So we’re now at that more formal seed stage, whereas pre-seed was a bit of friends and family and a couple of institutional investors. And then Series A is, you’ve got product market fit and now it’s time to grow and scale the business.

Teresa Chahine: I feel like you’ve got product market fit, and it’s time to grow and scale the business. What differentiates the seed from the Series A? Or am I being naive and being like, “You’re Series A already?”

Ashlee Wisdom: Well, some would say that we’re close to product market fit, but with our business model, we have our first sign of traction with enterprise customers. Product market fit is, you have the repeatable business model. I have 10 different health plans, 10 different employers. That might be a bit ambitious, but I have a number of enterprise customers that are buying a consistent product from Health in Her HUE, and we’re on our way there but we haven’t quite validated it completely. Series A is when you’ve gotten to that validation and now you need to really hire the sales team and the team that will help you scale that business model.

Teresa Chahine: Got it. So I’m going to ask you about your enterprise customers, but before I do it, I wanted to ask one more question about the pre-seed because I know a lot of listeners might be like, “Wait, wait, wait, but how did you cobble together these angel investors and the firms?” And did you decide, here’s how much money I need and here’s who I’m going to target? Did you just see how much you could get? What was your approach as a first-time founder?

Ashlee Wisdom: So I took a step back. At one point I was talking to investors, investors that were not really aligned with the stage that we were at and we had lots of traction. So investors were reaching out to me to have meetings, but then—

Teresa Chahine: That’s a good place to be at.

Ashlee Wisdom: …but ultimately they wouldn’t write the check because we were too early for them. And I kept hearing, “Too early, too early.” So when you hear “too early” as a founder, that could mean two things. You really are too early or this investor doesn’t have conviction in your business and maybe it’s something about the way that you’re telling the story of the business that you’re not getting them over the wall to actually want to write the check. So I met with a mentor and I told her, “I’m having all these conversations but I’m not getting any commitments.” And she told me I should take a step back. There was a program called Female Founders Alliance—or the organization was Female Founders Alliance, now known as Graham and Walker Venture Fund. And they had a program to support women with fundraising.

So it was called Ready Set Raise, and for I want to say two to three months, I was just focused on getting my pitch deck together, getting clear on what the business model was going to be and how I was going to tell that story to investors. And the culmination of that program was us having a demo day, which is basically a day where you pitch to a group of angel investors and VCs that Graham and Walker had brought together to hear us pitch. And I got one of my first angel commitments from pitching there. And sometimes you need just the first commitment to then get other VCs or investors interested in what you’re building. And that’s how we were able to raise that first million.

Teresa Chahine: And that’s what allowed you to build the technology to start to get your first enterprise customers.

Ashlee Wisdom: Exactly, yes.

Teresa Chahine: So it sounds like, even though your end users are Black women seeking healthcare providers, they’re not the ones who are the economic buyers. So who’s paying for this? Who are the enterprise customers?

Ashlee Wisdom: So given the fact that it’s not Black women’s fault that they have this distrust with the healthcare system, and as I was building this company, I felt conflicted in asking them to pay for a solution for a problem that they did not cause. So it felt more equitable to have larger enterprises really be the ones to subsidize the cost of Health in Her HUE for Black women. And so our business model is really selling into employers and health plans where they pay for access to our membership and platform on behalf of their—if they’re an employer for their employees, if they’re a health plan—for their Black women members.

Teresa Chahine: Got it. So I understand how you pitched to your end users—you’re solving a problem for them—but then the people who are paying, what problem are you solving for them?

Ashlee Wisdom: I’m communicating to them that these disparities that we’re seeing is costing them a lot of money. And so our value proposition to employers particular is, you want to attract and retain diverse employees. And one of the ways to do that is to provide equitable healthcare benefits to your diverse employees and your Black women employees. And if you’re paying for health insurance for your employees, and your Black women employees are not having good healthcare experiences and they’re not engaging with healthcare, it’s costing you because they’re probably having time off from work because of conditions that could have been caught early. You’re investing in health insurance that they’re not utilizing in the way that they really should be utilizing it. But if you give them access to Health in Her HUE, we’ll support them with finding the right provider for them who will give them an accurate diagnosis. And these women will also be able to engage with healthcare in a more preventative way because we’re helping them find the right points of care and the right providers for them.

And then on the health plan side, we’re thinking through how we can drive down costs for them. So if for women, for example, fibroids, we’re going to be focusing on that this year, oftentimes Black women are told that they have to get a hysterectomy, which is a very invasive procedure, an expensive procedure. And there are less invasive procedures that can be offered to a woman if she has a diagnosis of fibroids. So, can go to a health plan and say, “Hey, we’ll reduce the number of unnecessary hysterectomies or reduce the number of unnecessary C-sections, and that’s saving money for you and also improving the experience that your members are having with their providers and with your health plan.”

Teresa Chahine: So the way I’m hearing this now, it just sounds to me like, well, great, this is a win-win. Everybody wins. Of course you should be doing this. And yet, I know that these disparities have persisted over centuries. So talk to me about some of the barriers against, why hasn’t anyone done this before? It seems so obvious, like, duh, of course you should do this. Of course they should pay you to do this.

Ashlee Wisdom: This work is hard. Building in healthcare, it’s really hard. It’s super regulated. And also the healthcare system has traditionally, unfortunately been traditionally known to be slow when it comes to being open to innovation. And for some time, this issue of Black women and disparities was not top of mind for the healthcare ecosystem. I think COVID and the current social climate that we’re in right now has forced people to reckon with these disparities and also reckon with the economic cost of these disparities. And now there is more vested interest in solving this problem.

I wish that it was purely altruistic and for altruistic reasons, but making the business case of racial disparity is costing the healthcare system in our larger economy a lot of money—you should be paying attention to this. That has forced or made the healthcare system prioritize health equity. But it takes time to build up that political will, so to speak. And if you’re a startup that has this great idea, this great mission, but the timing and people aren’t receptive to what you’re trying to educate them on, that can create a barrier in getting buy-in and getting deals done.

Teresa Chahine: So now you’re talking to venture capitalists, and they’re interested in this topic. I’ve never actually navigated talking to venture capital and getting VC funding, but I’ve heard from so many different entrepreneurs about the pros and cons and things that you need to look out for. And so what has that looked like for you now? It sounds like there’s a lot of interest. Are you in a position where you are the one vetting the VCs instead of the other way around? And what are you looking for to make sure you have that alignment?

Ashlee Wisdom: I’m definitely doing a lot more the vetting because this mission is really important and VCs are looking for their return on investment. And so I know that by becoming a venture-backed company, that is what I’ve signed up to do, is to give these investors their return. But as a founder of Health in Her HUE with this important mission, it’s also my duty to make sure that this mission is executed in the way that it should be executed. And sometimes there can be tension, I’ll use the word tension between getting to that point of return but also getting there in a way that honors the mission of the company.

So for me, the way that I’m addressing that or trying to optimize for holding that tension in a healthy way is making sure that I’m seeking out investors that have a thesis of investing in healthcare and digital health companies and diverse founders and early-stage founders and making sure that they are bought into the mission of Health in Her HUE. Really, really bought into it. And the way that I vet that is looking at other companies in their portfolio that they’ve invested in, getting to know some of the founders in healthcare that have been invested in by these companies to know, “Do your investors actually know the sales cycles of selling into a health plan?” And doing that type of evaluation has been top of mind and a priority for me as I’m raising this current round.

Teresa Chahine: And it seems like there is a lot of funding for this kind of work. There are the kind of VCs whose mission might not be aligned and whose interests might not be aligned, but it sounds like there are a lot who are also investing in entrepreneurship that is solving for social problems. What advice do you have for other first-time founders who are navigating this landscape and figuring out who they want to talk to, how they want to position themselves, and how they can make sure to find that right alignment and that match?

Ashlee Wisdom: I would say first-time founders should really think through what are the nuances of their business and how they’re going about building it and trying to find a diversity of investors that will be beneficial to those different aspects. So for us, we are a healthcare startup. We want investors who understand how to sell into a health plan, how to sell into employers, what those business models look like, but we care a lot about the end user’s experience. And so while we do need to optimize for who’s buying and paying for the product, we don’t want to do that at the expense of creating a bad user experience for the end user because then we’re not going to have the engagement.

So it’s important for me to have investors who can appreciate having a very scalable business model within healthcare but also that doesn’t dilute the consumer experience. I want investors who are really interested in D2C, who know what it’s like to build a product that delights the end user. And so I would encourage first-time founders to think about their business, their product, and making sure that they have investors that can support them with making sure that they’re accounting for all the nuances of their business.

Teresa Chahine: So it’s a delicate balance. You want people who have invested in people like you who clearly care about this field of work, but also who know things you don’t.

Ashlee Wisdom: Exactly.

Teresa Chahine: Like what expertise do you need, what networks do you need that you don’t have contacts, potential partnerships? So it’s both about the financial support and the non-financial support.

Ashlee Wisdom: Absolutely.

Teresa Chahine: So tell me, where do you see Health in Her HUE going 10 years from now? What does it look like and what has it changed about the world? I know you’ve helped Black women find Black providers. What else? What would you like to change about the landscape?

Ashlee Wisdom: I would love for Health in Her HUE to support the broader healthcare ecosystem with seeing a model that can help them provide more affirming care to Black women and women of color. I don’t want, 5, 10 years from now, women are still feeling like they need to come to Health in Her HUE to find affirming care, but that we played a big part and a huge role in supporting different healthcare organizations and institutions with having models of care that really can meet the needs of traditionally, and even contemporarily, marginalized patient communities and patient populations. So that’s my big goal of having Health in Her HUE transform the way the current healthcare system operates.

And then also, wanting to actually improve the health outcomes of Black women. I want to see Black women excited about engaging with healthcare in a preventative way and not having trepidation. If Health in Her HUE can play a role in doing that, helping Black women engender trust with the healthcare system because they have a trusted healthcare provider and they’re engaging with healthcare more preventatively and it’s improving outcomes and reducing disparities, I will feel like I accomplished exactly what I set out to accomplish when I started building this company.

Teresa Chahine: So you’re thinking about all the things venture capitalists want, number of users and all that stuff, and you’re also thinking about so much more.

Ashlee Wisdom: Yes.

Teresa Chahine: Which is what makes you a public health entrepreneur. Yes, you’re going to have lots of users, and you already are, but you’re not stopping at trapping them into being your users, into being the only source for them, but also being an entry point into the health system, into having them engage with preventative care, which will improve health outcomes. And really, I think that’s where the health equity conversation gets hijacked when people want to check a box, but they’re not actually looking at “Are we actually changing the outcomes?” And you’re thinking a lot about the experience in order to get to a place where someone is engaging with the health system to change health outcomes, it’s actually the process and the experience that needs to change. Can you tell us more what you mean by affirming care?

Ashlee Wisdom: So I would say affirming care is care that takes into account the lived experiences of the patient population that you’re trying to best serve. So as a Black woman, I want my doctor to know or have a general understanding of the barriers that I face navigating the world, especially in the context of the U.S. as a Black woman, and take that into consideration as they’re providing care. So that may mean asking me certain questions about, “What’s going on in work and how are you managing stress?” and creating that safe space where I feel comfortable talking about what’s happening in my world and how those things are impacting my health and my ability to manage my health.

So that’s really what I mean about affirming care. And I want all providers—I don’t just want Black doctors or doctors of color to be responsible for providing that care to Black women; it’s my goal and hope that all providers will take on the initiative of learning how to be more culturally responsive so that they can provide that affirming care to patients at intersecting identities, not just because you’re a Black woman, but someone may be Black and may identify as LGBTQ+. All aspects of their identity should be taken into account as they’re receiving care.

Teresa Chahine: And that’s why I asked, because you mentioned the ultimate goal is that your patient population navigates the health system and improves their health outcomes. And also that others pay attention about, “Oh, that’s what this patient population needs. How can I actually provide that? I don’t have to be a Black woman, but I can still do my best to engage with a Black woman patient and think about what may be the nonclinical factors that are playing a part in her health outcomes.”

Ashlee Wisdom: Exactly.

Teresa Chahine: So that’s framework change. That’s really expanding your impact at the highest level beyond scaling the number of users.

Ashlee Wisdom: And I credit that to my public health background. When people ask me about what the bigger vision is, that’s immediately where my mind goes. It’s not the sexy tech response of, “We’re going to have...” And I do want us to have a successful exit of the company, but really, I want the financial return for my investors and for myself, but primarily I really care about driving those better outcomes for Black women. If that’s done, then I will feel like this work was not for naught.

Teresa Chahine: Well, also, that’s what will make the impact of this company different than if someone else had done it. And this is a space that everyone wants to play in now. And so this same company could be built by a White male, for example, in Silicon Valley and would get acquired and would make money for themselves and for their investors. And by being built by someone with a public health background who is also a Black woman, you’re going to make money for your investors and yourself, and you’re going to do it in a way where you understand the needs of your patients and have that at front and center. And also you’re thinking about changing the way other people engage with Black women—

Ashlee Wisdom: Exactly.

Teresa Chahine: Not just Health in Her HUE. That’s the difference between someone with a public health background and someone with lived experience and all the other people who are probably fighting to get into this space and compete with you. As a public health person, I’m just so proud and pleased with what you’re doing and—

Ashlee Wisdom: Thank you.

Teresa Chahine: My students, it resonated with them so much, and I could tell by the way we had a hard time getting down here to the media lab after class because they had so many questions. And we all just want to support you in any way I can, and we’re so grateful to you for doing this work.

Ashlee Wisdom: Thank you. It felt good to be amongst people who were thinking about this work from the lens that I often think through it, because it’s not every day that I’m having those types of conversations. So that was refreshing.

Teresa Chahine: We can’t wait to see you get all the funding and see how you’re going to disrupt this field. Thank you so much for taking the time to share your work with us today.

Ashlee Wisdom: Thank you for having me.

Teresa Chahine: Thanks Ashlee.

I’m Teresa Chahine, and you’ve been listening to Impact & Innovation. Subscribe to stay tuned and follow us at @TeresaChahine and @SOMVentures. Special thanks to the broadcast center at Yale School of Management.